Welcome to our Patient Education page!
Screening or Diagnostic Colonoscopy?
The patient has past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia and/or any other abnormal tests OR the patient is currently asymptomatic (no gastrointestinal symptoms either past or present) but has a personal history of GI disease, personal and/or family history of colon polyps and/or colon cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (e.g. every 2-5 years).
Insurance plans process these claims subject to the individuals deductible and co-insurance requirements.
Preventative Screening Colonoscopy:
The patient is asymptomatic (no gastrointestinal symptoms either past or present), age 50 or greater, has no personal or family history of GI disease, colon polyps, and/or cancer. The patient has not undergone a colonoscopy within the last 10 years.
Insurance plans usually process these claims under the wellness benefit, payable at 100% if it is a benefit of the individual’s health insurance plan.
Frequently asked questions:
Who will bill me?
You may receive bills for your procedure from the physician, the facility, anesthesia, pathologist and/or laboratory.
Can the physician change, add, or delete my diagnosis so that my procedure can be considered a preventative/wellness/routine screening?
NO! The patient encounter is documented as a medical record from the information you have provided, as well as what is obtained during our pre-procedure history and assessment. It is a binding legal document that cannot be changed to facilitate better insurance coverage.
What if my insurance company tells me that the doctor can change, add or delete a CPT or diagnosis code?
This happens a lot. Often the representative will tell the patient that if the “doctor had coded this as a screening, it would be paid at 100%." A member services representative should never suggest a physician alter a medical record for billing purposes.
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FAQS - Frequently Asked Questions
This information was developed by the Publications Committee of the American Society for Gastrointestinal Endoscopy (ASGE). For more information about ASGE, visit www.asge.org.
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you consult your doctor about your specific condition.
Colon Cancer Screening Saves Lives
Approximately 150,000 new cases of colorectal cancer are diagnosed every year in the United States and nearly 50,000 people die from the disease. It has been estimated that increased awareness and screening would save at least 30,000 lives each year. Colorectal cancer is highly preventable and can be detected by testing even before there are symptoms. The American Society for Gastrointestinal Endoscopy encourages everyone over 50, or those under 50 with a family history or other risk factors, to be screened for colorectal cancer.
Six Questions That Could Save Your Life
(or the Life of Someone You Love)
Test your knowledge about colorectal cancer (CRC) screening. If you think the answer is true or mostly true, answer true. If you think the answer is false or mostly false, answer false.
1. Colorectal cancer is predominantly a "man's disease," affecting many more men than women annually.
FALSE. Colorectal cancer affects an equal number of men and women. Many women, however, think of CRC as a disease only affecting men and might be unaware of important information about screening and preventing colorectal cancer that could save their lives, says the American Society for Gastrointestinal Endoscopy.
2. Only women over the age of 50 who are currently experiencing some symptoms or problems should be screened for colorectal cancer or polyps.
FALSE. Beginning at age 50, all men and women should be screened for colorectal cancer EVEN IF THEY ARE EXPERIENCING NO PROBLEMS OR SYMPTOMS.
3. A colonoscopy screening exam typically requires an overnight stay in a hospital.
FALSE. A colonoscopy screening exam is almost always done on an outpatient basis. A mild sedative is usually given before the procedure and then a flexible, slender tube is inserted into the rectum to look inside the colon. The test is safe and the procedure itself typically takes less than 45 minutes.
4. Colorectal cancer is the third leading cause of cancer deaths in the United States.
TRUE. After lung cancer, colorectal cancer is the third leading cause of cancer deaths in the United States. Annually, approximately 150,000 new cases of colorectal cancer are diagnosed in the United States and 50,000 people die from the disease. It has been estimated that increased awareness and screening would save at least 30,000 lives each year.
5. Tests used for screening for colon cancer include digital rectal exam, stool blood test, flexible sigmoidoscopy and colonoscopy.
TRUE. These tests are used to screen for colorectal cancer even before there are symptoms. Talk to your healthcare provider about which test is best for you. Current recommended screening options* include:
Beginning at age 50, men and women should have:
- An annual occult blood test on spontaneously passed stool (at a minimum);
- A flexible sigmoidoscopy every 5 years; or,
- A complete colonoscopy every 10 years.
Important: You may need to begin periodic screening colonoscopy earlier than age 50 years if you have a personal or family history of colorectal cancer, polyps or long-standing ulcerative colitis.
6. Colon cancer is often preventable.
TRUE. Colorectal cancer is highly preventable. Colonoscopy may detect polyps (small growths on the lining of the colon). Removal of these polyps (by biopsy or snare polypectomy) results in a major reduction in the likelihood of developing colorectal cancer in the future.
For Your Information
The American Society for Gastrointestinal Endoscopy encourages you to talk with your healthcare provider about colon cancer screening and encourages everyone over the age of 50 to undergo the appropriate screening. If your primary healthcare provider has recommended a colonoscopy, you can find a physician with specialized training in these GI endoscopic procedures by using the free Find a Doctor tool on ASGE's Web site at www.screen4coloncancer.org. For more information about colon cancer screening, visit www.screen4coloncancer.org.